Field of the Invention
The invention relates generally to devices and methods for performing surgical procedures. More particularly, the invention provides a device and method for suturing closed an opening through tissue into a body cavity. The invention will find particular use in laparoscopic and other types of minimally invasive surgery.
Minimally invasive surgery, including laparoscopic, endoscopic, and arthroscopic surgery, is generally performed through small incisions using instruments specially adapted for these procedures. These techniques offer significant advantages over conventional "open" surgery techniques. In particular, trauma to the patient is greatly reduced and recovery times are significantly shorter. For these and other reasons, minimally invasive surgeries are often much less costly than corresponding conventional surgical techniques.
Incisions made while performing minimally invasive surgery can be very small (a few millimeters), or somewhat larger (a few centimeters). Currently, in laparoscopic procedures, incisions larger than about five millimeters are typically sutured closed after completion of the surgery to prevent herniation. Suturing of such small incisions is problematic, however, for the simple reason that the surgeon can not get his fingers and/or instruments into the incision to suture the incision in the conventional manner.
Suturing of such small incisions is difficult enough in thin patients, and even more difficult in overweight or obese patients. In these patients, the thick layer of fat underlying the skin makes it difficult to reach the fascia, a layer of tough, fibrous tissue through which the suture should be anchored. For these reasons, it would be advantageous to provide special tools and methods to facilitate suturing of surgical incisions made during minimally invasive surgeries.
An existing tool for suturing small incisions is called a Grice needle. This device is a long needle into which a suture can be threaded. The needle is pushed through the fascia on one side of the incision into the patient's body cavity. The suture is then retrieved using a second needle which is penetrated on the opposite side of the incision which has an integral suture snare. Although workable, the use of the Grice needle can be problematic in closing trocar penetrations made in laparoscopic and other minimally invasive procedures, particularly after the viewing scope has been removed. Problems can also arise when the Grice needles are used in blind procedures where the extent of needle penetration cannot be observed.
Another device for suturing percutaneous penetrations is described in a sales brochure published by Rema-Medizintechnik GmbH (Germany). The Rema "Deep Suture" device includes a handle, a control screw, and a shaft upon which a pair of special needles are mounted. Although operation is not clearly described, the device is apparently used by inserting the shaft through an incision and turning the control screw to deploy a pair of needles radially outward so that they lie on opposite sides of the penetration. The device is then hand lifted to penetrate the needles through the fascia from inside the body. The needles are then removed from the handle, and suture extending between the needles pulled and tied to close the penetration.
While perhaps offering some improvement over the Grice needle, the Rema device is less than ideal in some significant respects. First, the Rema device is complex and would be costly to produce. Second, the fixed positioning of the special needles on the shaft limits the surgeon's flexibility in placing sutures around the incision. Additionally, the needles are directed outward in a parallel fashion and exit through the skin. Thus, the surgeon is not able to suture the fascia while allowing the overlying tissue to heal without sutures. The device is likely too expensive to be disposable and must therefore be cleaned and carefully sterilized between uses. Adequate cleaning and sterilization of a surgical device, especially one having a number of recesses in which blood can collect, is often difficult to achieve.
For the reason noted above, it would be advantageous to provide an improved suturing device and method. Ideally, the improved device would be compact and of simple construction. The device should allow for flexibility in deployment, and in particular should allow the surgeon to suture the fascia layer and/or peritoneum in percutaneous penetrations without suturing the overlying tissue (thus providing a more secure suture with reduced scarring). It would be particularly advantageous if the improved device could be made sufficiently inexpensive to be disposable so that resterilization would not be required.